Individual
BROCK BODILY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10623 S REDWOOD RD # 101, SOUTH JORDAN, UT 84095-2481
(801) 566-4242
Mailing address
1265 N 850 E, PLEASANT GROVE, UT 84062-1998
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
11353289-8002
UT
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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